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LETTER TO THE HOUSEHOLD
Dear Parent/Guardian:
This letter is intended for parents or guardians of children enrolled in a child care center. (Name of Center) ________________ offers healthy
meals to all enrolled children as part of our participation in the United States Department of Agriculture’s (USDA) Child and Adult Care Food
Program (CACFP). The CACFP provides reimbursements for healthy meals and snacks served to children enrolled in child care. Please help us
comply with the requirements of the CACFP by completing the attached CACFP Family-Size and Income Application (FSIA). In addition, by
filling out this application, we will be able to determine if your children qualify for free or reduced-price meals.
1. Do I need to fill out an FSIA for each of my children in day care? You may complete and submit one FSIA for all children enrolled in child
care in your household ONLY if the children in child care are enrolled in the same center. We cannot approve an FSIA that is not complete, so
be sure to read the instructions carefully and fill out all required information. Return the completed FSIA to: (Name of Center)
_______________________________________ , (Address) __________________________________ , (Phone Number)
____________________________ .
2. Who can get free meals without providing income information? Children in households getting Supplemental Nutrition Assistance
Program (SNAP), Temporary Assistance for Needy Families (TANF), or Food Distribution Program on Indian Reservations (FDPIR) can get
free meals. Foster children and children enrolled in Head Start are also eligible for free meals. Children in households participating in Women
Infants and Children (WIC) MAY be eligible for free meals.
3. Who can get reduced-price meals? Your children can get low-cost meals if your household income is within the reduced-price limits on the
Income-Eligibility Guidelines, shown on this application. Children in households participating in WIC MAY be eligible for reduced-price
meals.
4. May I fill out an FSIA if someone in my household is not a United States (U.S.) citizen? Yes. Your or your children do not have to be U.S.
citizens to qualify for meal benefits offered at the child care center.
5. Who should I include as members of my household? You must include all people in your household (such as grandparents, other relatives,
or friends who live with you). You must include yourself and all children who live with you. You also must include foster children who live
with you.
6. How do I report income information and changes in employment status? The income you report must be the total gross income listed by
source for each household member received last month. If last month’s income does not accurately reflect your circumstances, you may
provide a projection of your monthly income. If no significant change has occurred, you may use last month’s income as a basis to make this
projection. If your household’s income is equal to or less than the amounts indicated for your household’s size on the attached Income-
Eligibility Guidelines, the center will receive a higher level of reimbursement. Once properly approved for free or reduced-price benefits,
whether through income or by providing a current SNAP, TANF, FDPIR case number, you will remain eligible for those benefits for the
current fiscal year. You should notify us, however, if you or someone in your household becomes unemployed and the loss of income causes
your household income to be within the eligibility standards.
7. What if my income is not always the same? List the amount that you normally get. For example, if you normally get $1000 each month but
you missed some work last month and only got $900, put down that you get $1000 per month. If you normally get overtime, include it, but not
if you only get it sometimes.
8. What if I have foster children? Foster children that are under the legal responsibility of a foster care agency or court are eligible for free
meals. Any foster child in the household is eligible for free meals regardless of income. Households may include foster children on the FSIA
but are not required to include payments received for the foster child as income. Households wishing to apply for such benefits for foster
children should contact (Name) __________________________________________________ , (Address)
_____________________________________________________ , (Phone Number) _______________________ .
9. We are in the military; do we include our housing and supplemental allowance as income? If your housing is part of the Military
Housing Privatization Initiative and you receive the Family Subsistence Supplemental Allowance, do not include these allowances as income.
Also, in regard to deployed service members, only that portion of a deployed service member’s income made available by them or on their
behalf to the household will be counted as income to the household. Combat Pay, including Deployment Extension Incentive Pay (DEIP) is
also excluded and will not be counted as income to the household. All other allowances must be included in your gross income.
In the operation of child feeding programs, no person will be discriminated against because of race, color, national origin, sex, age, or disability.
If you have other questions or need help, call (Phone Number) ___________________________________ .
Sincerely,
(Signature) ____________________________________________

LETTER TO THE HOUSEHOLD
Dear Parent/Guardian:
This letter is intended for parents or guardians of children enrolled in a child care center. (Name of Center) ________________ offers healthy
meals to all enrolled children as part of our participation in the United States Department of Agriculture’s (USDA) Child and Adult Care Food
Program (CACFP). The CACFP provides reimbursements for healthy meals and snacks served to children enrolled in child care. Please help us
comply with the requirements of the CACFP by completing the attached CACFP Family-Size and Income Application (FSIA). In addition, by
filling out this application, we will be able to determine if your children qualify for free or reduced-price meals.
1. Do I need to fill out an FSIA for each of my children in day care? You may complete and submit one FSIA for all children enrolled in child
care in your household ONLY if the children in child care are enrolled in the same center. We cannot approve an FSIA that is not complete, so
be sure to read the instructions carefully and fill out all required information. Return the completed FSIA to: (Name of Center)
_______________________________________ , (Address) __________________________________ , (Phone Number)
____________________________ .
2. Who can get free meals without providing income information? Children in households getting Supplemental Nutrition Assistance
Program (SNAP), Temporary Assistance for Needy Families (TANF), or Food Distribution Program on Indian Reservations (FDPIR) can get
free meals. Foster children and children enrolled in Head Start are also eligible for free meals. Children in households participating in Women
Infants and Children (WIC) MAY be eligible for free meals.
3. Who can get reduced-price meals? Your children can get low-cost meals if your household income is within the reduced-price limits on the
Income-Eligibility Guidelines, shown on this application. Children in households participating in WIC MAY be eligible for reduced-price
meals.
4. May I fill out an FSIA if someone in my household is not a United States (U.S.) citizen? Yes. Your or your children do not have to be U.S.
citizens to qualify for meal benefits offered at the child care center.
5. Who should I include as members of my household? You must include all people in your household (such as grandparents, other relatives,
or friends who live with you). You must include yourself and all children who live with you. You also must include foster children who live
with you.
6. How do I report income information and changes in employment status? The income you report must be the total gross income listed by
source for each household member received last month. If last month’s income does not accurately reflect your circumstances, you may
provide a projection of your monthly income. If no significant change has occurred, you may use last month’s income as a basis to make this
projection. If your household’s income is equal to or less than the amounts indicated for your household’s size on the attached Income-
Eligibility Guidelines, the center will receive a higher level of reimbursement. Once properly approved for free or reduced-price benefits,
whether through income or by providing a current SNAP, TANF, FDPIR case number, you will remain eligible for those benefits for the
current fiscal year. You should notify us, however, if you or someone in your household becomes unemployed and the loss of income causes
your household income to be within the eligibility standards.
7. What if my income is not always the same? List the amount that you normally get. For example, if you normally get $1000 each month but
you missed some work last month and only got $900, put down that you get $1000 per month. If you normally get overtime, include it, but not
if you only get it sometimes.
8. What if I have foster children? Foster children that are under the legal responsibility of a foster care agency or court are eligible for free
meals. Any foster child in the household is eligible for free meals regardless of income. Households may include foster children on the FSIA
but are not required to include payments received for the foster child as income. Households wishing to apply for such benefits for foster
children should contact (Name) __________________________________________________ , (Address)
_____________________________________________________ , (Phone Number) _______________________ .
9. We are in the military; do we include our housing and supplemental allowance as income? If your housing is part of the Military
Housing Privatization Initiative and you receive the Family Subsistence Supplemental Allowance, do not include these allowances as income.
Also, in regard to deployed service members, only that portion of a deployed service member’s income made available by them or on their
behalf to the household will be counted as income to the household. Combat Pay, including Deployment Extension Incentive Pay (DEIP) is
also excluded and will not be counted as income to the household. All other allowances must be included in your gross income.
In the operation of child feeding programs, no person will be discriminated against because of race, color, national origin, sex, age, or disability.
If you have other questions or need help, call (Phone Number) ___________________________________ .
Sincerely,
(Signature) ____________________________________________